Global Changes in Cardiovascular Endurance of Children and Youth Since 1964

Introduction: Cardiovascular endurance is considered to be an important marker of current health and even a predictor of future health.

Aim/hypothesis: This study aimed to systematically analyze the available scientific information on time changes in maximal long-distance running performance (a widely and long-used marker of cardiovascular endurance) of children and youth. We hypothesized that cardiovascular endurance performance has declined in recent decades.

Methods: A systematic review of the scientific literature was undertaken to locate studies reporting on time changes in maximal long-distance running performance of apparently healthy (free from known disease or injury) children and youth aged 9-17 years. Studies were located up to January 2013 via computerized searching of bibliographical databases, reference list searching and personal communication with international experts.

Time changes were analyzed at the study by country by sex by age by test level using best-fitting linear or polynomial regression models relating the year of testing to long-distance running performances expressed as average running speeds. Changes in means were expressed as percent changes and as standardized effect sizes.

Results: Fifty studies reporting time changes in cardiovascular endurance performance of more than 25 million 9-17 year olds from 28 countries over the period 1964-2010 were included. Overall, there has been a large decline (mean ±95% confidence interval) in cardiovascular endurance performance equivalent to about -14 ±1% or -1.0 ±0.1 standard deviations. Time-related declines were similar for boys and girls, children and youth, and different geographical regions, but were variable between countries.

Conclusions: There is overwhelming evidence for substantial global declines in cardiovascular endurance performance of children and youth in recent decades. Time-related declines in cardiovascular endurance performance are probably caused by a network of social, behavioral, physical, psychosocial and physiological factors. These declines highlight the need for regular surveillance of child and youth health-related fitness and proactive public health strategies.

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